I. Injury. In cases of student injury, the following procedures will be implemented:

A. The student will be made comfortable and not moved until attended by District personnel who have been trained in first aid. The principal, school nurse, or health aid will be notified.

B. Call 911 immediately when in the judgment of the principal, the school nurse, or a staff member trained in first aid, the injury requires the attention of emergency medical personnel. District personnel will remain with the student whenever practical until relieved or excused by emergency medical personnel.

C. Unless the injury is of a minor nature that does not require first aid, the student's parents or guardian will be notified.

1. When the parents or guardian are notified of injuries resulting from an accident, they will be told what has happened and what has been done.

2. In addition, the parents or guardian will be given any other relevant information that the District possesses.

3. If the parents or guardian cannot be reached, the student's emergency contact person will be notified.

D. An accident resulting in injury considered to be more than minor in nature requires the completion of a District accident report and the incident will be reported to the building principal or nurse and the Director of Student Services.

II. Illness. In cases of student illness, the following procedures will be implemented:

A. Call 911 immediately when in the judgment of the principal, the school nurse, or a staff member trained in first aid, the illness requires the attention of emergency medical personnel. District personnel will remain with the student whenever practical until relieved or excused by emergency medical personnel or when trained District personnel respond in accordance with procedures for life-threatening asthma attacks and systemic allergic reactions and they are relieved by emergency medical personnel.

B. Unless the illness is of a minor nature that does not require first aid, the student's parents or guardian will be notified.

1. When the parents or guardian are notified of an illness, they will be told what has happened and what has been done.

2. In addition, the parents or guardian will be given any other relevant information that the District possesses.

3. If the parents or guardian cannot be reached, the student's emergency contact person will be notified.

C. Except in cases of minor illnesses, illnesses will be reported to the building principal or nurse and the Director of Student Services.

III. Definitions.

A. Emergency medical personnel. Emergency medical personnel shall mean medical personnel who can respond to a medical emergency.

B. Minor injury. Minor injury shall mean an injury which does not require the attention of a physician, an advanced practice registered nurse, or a physician's assistant; is not life threatening; does not pose a health risk,; and can be effectively treated with first aid which can be performed by a school nurse or a health aid who has been trained in first aid.

C. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulation and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

D. Advanced practice registered nurse. Advanced practice registered nurse shall mean individuals who are licensed and practicing under and in accordance with the Advanced Practice Registered Nurse Act.

E. Physician assistant. Physician assistant shall mean individuals who are 
licensed under Neb. Rev. Stat. §§ 38-2046 through 38-2055 to perform medical services under the supervision of a licensed physician.

I. General Statement. Prescribed medication shall not be brought to school unless the written directions of a physician, physician assistant, or advanced practice registered nurse state that the prescribed medication must be taken during school hours or during school activities.

II. Rules for all Medications.

A. Preschool, Elementary and Middle School Levels. The following rules shall apply to the use, application, and transportation of all medications at the preschool, elementary school, and middle school levels.

1. Non-Prescribed Medication. A written authorization must be signed by the student's parents or guardian and filed with the school nurse or principal permitting the use of non-prescribed medication.

2. Prescribed Medication. The student or the student's parents or guardian must provide the school nurse or principal with a written order of a physician, physician assistant, or advanced practice registered nurse that prescribes the type and amount of medication. A current prescription label will satisfy the requirements of this paragraph. In addition, a written authorization permitting the use of medication must be signed by the student's parents or guardian and filed with the school nurse or principal.

3. Taking of Non-Prescribed and Prescribed Medication. The ingestion, taking, or application of non-prescribed and prescribed medications, including nebulizers, shall be performed under the direct supervision and observation of the school nurse, principal, or principal's designee, who shall have successfully completed a District competency assessment pursuant to the Medication Aide Act and applicable state rules and regulations, will be administered as directed on the manufacturer’s label, as directed by the student's physician, physician assistant, or advanced practice registered nurse. The school nurse or health room paraprofessional may assist a student with eye drops or eardrops if the school nurse or health room paraprofessional deems it appropriate or the student is unable to effectively administer such. If the student’s parents or guardian have given written authorization, students will be allowed to possess and/or ingest glucose tablets as needed anywhere on school grounds.

4. Homeopathic Substances, Herbs, and Vitamins. Homeopathic substances, herbs, and vitamins shall not be administered by school staff unless prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law. Homeopathic substances, herbs and vitamins, whether prescribed or non- prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

5. Transporting Medications to and from School.

a. Preschool and Elementary Schools. In the preschool and elementary schools, students shall not be allowed to transport non-prescribed or prescribed medications to and from school with the exception of glucose tablets. Elementary school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. Non-prescribed or prescribed medications must be transported by the student’s parents or guardian or by an adult designated in writing by the parents or guardian, and must be delivered to the school nurse, principal, or the principal’s designee.

b. Middle School. Middle school students shall not be allowed to transport prescribed medications to and from school with the exception of glucose tablets. Middle school students may possess and use inhalers according to the provisions of Section II(F)(1) of this Rule. Prescribed medications must be transported by the student’s parents or guardian or by an adult designated in writing by the parents or guardian. Non- prescribed medications may be transported by middle school students to and from school but must be delivered to the school nurse, principal, or the principal’s designee.

B. High School. The following rules shall apply to the use and application of medications at the high school level.

1. Non-Prescribed Medication. No written authorization shall be required for non-prescribed medication. However, if a teacher, principal or school nurse observes frequent or inappropriate use by a student of non-prescribed medication, the school may require the following:

a. Written authorization by the student's parents or guardian permitting the possession and use of the non-prescribed medication; and/or

b. A written statement signed by a physician, physician assistant, or advanced practice registered nurse permitting the use of the non-prescribed medication.

2. Prescribed Medication. If prescribed medication is to be ingested, taken or applied, the following shall be required:

a. The medication shall be delivered to the school nurse, principal, or principal's designee;

b. A written authorization signed by the student's parents or guardian permitting the possession and use of the medication shall be filed with the school nurse or principal;

c. The school nurse or principal shall be provided with the written order of a physician, physician assistant, or advanced practice registered nurse prescribing the medication, and its dosage; and

d. The ingestion, taking or application of prescribed medication, including nebulizers, shall be performed under the direct supervision and observation of the school nurse, principal, or principal's designee, who shall have successfully completed a District competency assessment pursuant to the Medication Aide Act and applicable state rules and regulations, and as directed by the physician, physician assistant, or advanced practice registered nurse. If the student’s parents or guardian have given written authorization, students will be allowed to possess and/or ingest glucose tablets as needed anywhere on school grounds and to possess and administer inhalers according to the provisions of Section II(F)(1) of this Rule.

3. Homeopathic Substances, Herbs, and Vitamins. Homeopathic substances, herbs, and vitamins shall not be administered by school staff unless prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law. Homeopathic substances, herbs and vitamins, whether prescribed or non- prescribed, shall be subject to the same restrictions and requirements as prescribed medications.

C. Administration of Injections. Only school nurses and school personnel who have been trained to administer the Epi-Pen or Glucagon and are giving injections in emergency life-saving situations may administer injections at school.

1. Glucagon Injections. If a student requires administration of Glucagon in an emergency diabetic attack, school personnel will call 911. The Glucagon will be provided by the student’s parents or guardian. School personnel other than the school nurse may administer Glucagon injections only in emergency situations if they are trained by qualified personnel.

2. Epi-pen Injections. Students may use/carry Epi-Pens without supervision or monitoring by the school nurse or principal. The Epi- Pen must be a prescribed medication and the school nurse or principal shall have received written permission from the student’s parents or guardian as well as a written order from a physician, physician assistant, or advance practice registered nurse. All other injections that are given in response to an emergency should be given by a school nurse if available. An emergency medical unit and the student's parents or guardian shall be called.

3. Other Injections. If a student requires any injections during the school day, students may administer injections in the nurse’s office or an area designated by the principal or the principal’s designee. Parents may request that a school nurse administer injections if the student is incapable of self-administration. Parents shall submit requests to the Director of Student Services.

D. Record Keeping.

1. Authorization and Medical Directions File. The school nurse, principal, or principal's designee for each school shall keep a file which shall contain the following:

a. All authorizations required under this Rule;

b. All orders or instructions from a physician, physician assistant, or advanced practice registered nurse;

c. The dates that authorizations and/or orders of a physician, physician assistant, or advanced practice registered nurse are received; and

d. The date that medication is delivered to the nurse, principal, or principal's designee.

2. Daily Medication Documentation. In each school, a daily medication log shall be kept which shall contain the following:

a. The student's name;

b. The type of medication the student is authorized to have;

c. The dosage or directions for ingestion, taking, or application of the medication;

d. The name of the person supervising the student who is taking the medications

e. The time the medication is administered; and

f. Any refusal by the student to take and/or receive the medication.

E. Medical Information to be Provided to the District.

1. Medical Allergies, Seizures, and Susceptibility to Illness. If a student is either allergic to a certain medication or is prone to seizure or other illness, the student's parents, guardian, physician, physician assistant, or advanced practice registered nurse shall provide the District, in writing, with the following information on or by the first day of school:

a. The name of the medications to which the student is allergic;

b. The serious illnesses to which the student is susceptible; and

c. If the student is susceptible to an illness, what steps are to be taken by school personnel in the event the illness occurs.

2. Injections for Medical Emergencies. If a student is required to receive an injection for a medical emergency, the student's parents, guardian, physician, physician assistant, or advanced practice registered nurse shall notify the school, in writing, and provide the following information on or by the first day of school:

a. The name of the medication and its dosage; and

b. The method of administration (subcutaneous, intramuscular, intravenous, etc.).

F. Miscellaneous Provisions.

1. Inhalers. Students may use/carry inhalers without supervision or monitoring by the school nurse or principal. The inhaler must be a prescribed medication and the school nurse or principal shall have received written permission from the student's parents, guardian, as well as a written order from a physician, physician assistant, or advanced practice registered nurse. This statement shall also include directions of appropriate inhaler usage. If school personnel observe a student using an inhaler in excess of the directions on the inhaler or with a frequency which would be considered unreasonable, it shall be reported to the school nurse or principal in which case the student's use of the inhaler shall be supervised by the school nurse or principal.

2. Containers. All medication shall be kept in its original container with its original label which describes the ingredients of the contents, recommends dosages, and provides appropriate warnings. The label must be legible and be written in English, or provide English translations.

3. Custody and Storage. All medication delivered to the school nurse or principal shall be stored in a container or refrigerator in the nurse's office, principal's office, or other area designated by the school principal. The storage area shall either be locked or under the control of a designated school employee.

4. Quantity. No more than a thirty (30) day supply of prescribed medication shall be provided and delivered to the school by the student, student's parents or guardian, unless there is a written order by a physician, physician assistant, or advanced practice registered nurse requiring a greater supply.

5. Transfer to Other Students. Students are prohibited from transferring, delivering, or receiving any medication to or from other students. Violation of this subsection will authorize the confiscation of the medication by the District, and subject the students to discipline.

6. Finger Stick Blood Test. Students who have been taught finger stick blood tests shall follow those procedures that they have been taught. Parents of students who have diabetes, and/or students who have diabetes, should notify the school nurse or principal at the beginning of the school year that the student is diabetic, and should provide the school nurse or principal with all information required under this Rule. Students may administer the finger stick blood test in the nurse’s office or in another area designated by the principal or the principal’s designee.

III. Student Discipline. If a student violates a provision of this Rule, the student shall be subject to discipline.

A. In addition, where appropriate, the following people shall be immediately notified of a violation of this Rule:

1. The school nurse, principal, or principal's designee;

2. The student's parents or guardian; and

3. The physician, physician assistant, or advanced practice registered nurse prescribing the medication if deemed necessary.

B. While notifications are being given, the student shall remain in the custody of the school nurse, principal, or principal's designee until necessary notifications have been made and until actions have been taken to eliminate any possible threat to the student or other students.

1. If medications have been improperly dispensed or ingested by the student or other students, the student’s physician, physician assistant, or advanced practice registered nurse shall be requested to give the proper medical directions to be followed by the school staff. Unless otherwise directed by the physician, physician assistant, or advanced practice registered nurse, the school nurse, and principal or principal’s designee shall determine what action if any shall be followed to insure the student(s)’ safety.

2. If the physician, physician assistant, or advanced practice registered nurse cannot be reached and the school nurse or principal determines that an emergency exists, emergency medical personnel shall be immediately called. The parents or guardian shall be notified of any action being taken.

IV. Definitions.

A. Emergency medical personnel. Emergency medical personnel shall mean medical personnel who can respond to a medical emergency.

B. Medication. Medication shall be broadly defined and shall include:

1. All prescribed medications, over the counter and other non- prescribed medications, and all chemical substances, compounds, homeopathic substances, herbs, vitamins, and/or devices, which purport to aid in a person’s health or well-being or are intended for use in the diagnoses, cure, mitigation, treatment, or prevention of diseases, or are intended to affect the structure or any function of the body; and

2. Any device, instrument, apparatus, implement, machine, 
contrivance, implant, or other similar or related article, including any component part or accessory, which is prescribed by a physician, physician assistant, or advanced practice registered nurse and dispensed by a pharmacist or other person authorized by law.

C. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulations and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

D. Advanced practice registered nurse. Advanced practice registered nurse shall mean individuals who are licensed and practicing under and in accordance with the Advanced Practice Registered Nurse Act.

E. Physician assistant. Physician assistant shall mean individuals who are licensed under Neb. Rev. Stat. §§ 38-2046 through 38-2055 to perform medical services under the supervision of a licensed physician.

F. Qualified personnel. Qualified personnel shall mean individuals who have met an educational or legal requirement necessary to administer emergency injections.
 

I. Physical Examination and Visual Evaluation. Prior to the entrance of any student into kindergarten and the seventh grade or, in the case of a transfer from out of state, to any other grade in any District school, the parents or guardian must submit written evidence of a physical examination of the student by a physician, physician assistant, or advanced practice registered nurse.

A. The physical examination must have been performed within six (6) months of the date of enrollment. Either a completed, signed and dated physical exam report, or a printed or typewritten form signed by a qualified examiner indicating that a physical examination was administered on a specific date within the previous six (6) month period for the named student, constitutes sufficient evidence of compliance.

B. The cost of such physical examination is to be borne by the parents or guardian of each child examined.

C. No physical examination shall be required of any student whose parents or guardian objects thereto in writing.

D. All kindergartners and out of state transfer students will be required to submit written evidence of a visual evaluation by a physician, physician assistant, advanced practice registered nurse, or optometrist within six (6) months prior to admission. The visual evaluation shall consist of testing for amblyopia, strabismus, and internal and external eye health, with testing sufficient to determine visual acuity. A visual evaluation report that is signed and dated by a qualified examiner and including at a minimum the specific required tests, constitutes sufficient evidence of compliance. No such visual evaluation shall be required of any child whose parent or guardian objects in writing. The cost of such visual evaluation shall be borne by the parent or guardian of each child who is examined.

II. Immunization. All students by law are required to be protected by immunization against measles, mumps, rubella, varicella (chicken pox), poliomyelitis, diphtheria, pertussis, tetanus, Haemophilus influenza type b (Hib), Hepatitis B, and and invasive pneumococcal disease (for students 2-5 years of age), prior to enrollment and in accordance with the immunization standards prescribed in Title 173, Nebraska Administrative Code, Chapter 3-008.

A. Any student who does not comply with this provision shall not be permitted to continue in school until the student complies unless the student falls within the two (2) exceptions contained in this Rule.

B. Unless exempted by state law, the cost of such immunization shall be borne by the parents or guardian of each student who is immunized or by the Department of Health and Human Services for those students whose parents or guardian are unable to meet such cost.

C. Immunization shall not be required for enrollment if either of the following is submitted to the District:

1. A statement signed by a physician, physician assistant, or advanced practice registered nurse stating that, in the health care provider's opinion, the immunizations required would be injurious to the health and well-being of the student or any member of the student's family or household; or

2. A notarized affidavit signed by the student or, if the student is a minor, by a legally authorized representative of the student, stating that the immunization conflicts with the tenets and practice of a recognized religious denomination of which the student is an adherent or member or that immunization conflicts with the personal and sincerely followed religious beliefs of the student.

3. The physician's statement or affidavit shall be kept in the student's file.

D. A student may be provisionally enrolled in the District in the following circumstances:

1. The student has begun the immunizations required by state law and the student is receiving the necessary immunizations as rapidly as is medically feasible and in accordance with the requirements of Title 173, Nebraska Administrative Code, Chapter 3-010.02; or

2. The student is the child or legal ward of an active member of any of the military services of the United States or of his or her spouse, and the student is enrolling in the District following residence in another state or in a foreign country, and the parents or guardian of the student provide the District with a signed written statement certifying that the student has completed the immunizations required by state law. The student’s parents or guardian must thereafter provide the District with written evidence that the student has completed the immunizations required by state law, and if such written evidence is not provided to the District within sixty (60) days of the date of the provisional enrollment, then the student shall not thereafter be permitted to continue in school until such written evidence of compliance is provided.

III. Required Evidence of Immunization. For the purposes of compliance with the immunization requirements of state law, the student’s parents or guardian shall be required to present to the District the following evidence of immunization:

A. An immunization history containing the name of the vaccine, the month and year of administration (the month, day, and year for MMR vaccine), the name of the health practitioner, the agency where the immunization was obtained, and the signature of the physician, parent, guardian, or of such other person maintaining the immunization history of the student, verifying that the student has received these vaccines; or

B. Laboratory evidence of circulating antibodies for measles, mumps, or rubella shall constitute evidence of immunity against those diseases provided the following information is supplied: name of laboratory, name of test, test result, test date, signature of laboratory technician performing the test or of the laboratory director, and date of signature.

C. For purposes of compliance with this Rule, clinical history of measles, mumps, or rubella without laboratory or epidemiologic confirmation does not constitute evidence of immunity. Epidemiologic confirmation of a diagnosis means that the clinical history of measles, mumps, or rubella is corroborated by association with laboratory proven case(s) and that such epidemiologic case(s) have been reported to and counted by the Department of Health and Human Services.

IV. Health Screenings. Students in District schools must be screened periodically for vision, hearing, and dental health. In addition, the Department of Health and Human Services prescribes height and weight measurement for the purpose of monitoring weight/height status at intervals for all students.

A. If such health screening indicates a need for further evaluation and the necessity of professional attendance, the District shall notify the parents or guardian in writing and explain the necessity for further evaluation and professional attendance for such student.

B. A student is not required to submit to health screenings if the student’s parents or guardian provide a written statement signed by a physician, physician assistant, or advanced practice registered nurse attesting that the student underwent the required hearing, vision, and/or dental screening within the last six (6) months. For height and weight screenings, the written statement must object to such screening and be signed and dated by the student’s parents or guardian and be submitted before each time such screening is conducted.

C. The District's health screenings shall be conducted during the first quarter of each school year for students then in attendance. Thereafter, as students enter the District during the year, such health screenings shall be made immediately upon their entrance.

V. Parental Notification and Opportunity to Opt out of Participation. Pursuant to the Protection of Pupil Rights Amendment, 20 U.S.C. §1232h, the District shall provide reasonable notice at the beginning of the school year, directly to the parents and guardians of students enrolled in District schools, of the specific or approximate dates of any non-emergency invasive physical examination or screening that is required as a condition of attendance and administered by the District and scheduled in advance, and which is not necessary to protect the immediate health and safety of the student or other students.

A. An invasive physical examination is any medical examination that involves the exposure of private body parts, or any act during such an examination which includes incision, insertion, or injection into the body, but does not include a hearing, vision, dental, or scoliosis screening, or any physical examination or screening permitted or required by state law.

B. Parents, guardians, and students who are eighteen (18) years old or emancipated under state law, may opt out of participation in any such invasive physical examination by providing the District with a signed written statement which declines participation in any such invasive physical examination.

VI. Physical Examinations for Student Athletes. Students participating in activities sponsored by the Nebraska Schools Activities Association, athletics, cheerleading, or dance team, shall obtain a physical examination by a physician after May 1st, and shall submit the same to the District prior to participation.

A. The requirement of the obtaining and submission of a physical examination will be in force each year a student participates in student athletics.

B. Student athletes must also be covered by accident insurance prior to participation on any team. Student athletes are eligible to purchase insurance made available by the District.

VII. Definitions.

A. Student Athletics. Student athletics shall mean extracurricular school sponsored competitive interscholastic sports.

B. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulation and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

C. Advanced practice registered nurse. Advanced practice registered nurse shall mean individuals who are licensed and practicing under and in accordance with the Advanced Practice Registered Nurse Act.

D. Physician assistant. Physician assistant shall mean individuals who are licensed under Neb. Rev. Stat. §§ 38-2046 through 38-2055 to perform medical services under the supervision of a licensed physician.

I. General Statement. If a student has symptoms of a contagious or infectious disease, such student shall be sent home immediately or as soon as safe and proper transportation can be arranged, and the District’s Director of Student Services shall be at once notified. The Director of Student Services shall notify the student’s parents or guardian and the student will be excluded from school in accordance with the provisions of this Rule.

A. Students with a contagious or infectious disease may return to school when the symptoms disappear, and when the minimum isolation period has elapsed, provided however that students with HIV disease or Hepatitis B have complied with the procedures of Section III below.

B. The isolation period shall be in accordance with rules and regulations adopted by the Department of Health and Human Services.

C. This section shall not restrict or prohibit the District's authority to otherwise limit a student's activities in school where such limitation is necessary for the health or safety of the student or others.


II. Attending School. Students diagnosed with HIV disease or Hepatitis B will be allowed to attend school without restriction unless they manifest severe or unusually aggressive behavior, such as biting, or if they have weeping skin sores that cannot be covered.

A. In such instances, the student's parents or guardian will be notified and the student will be excluded from school.

B. Immediately thereafter, a determination of the appropriate educational setting will be made by a team consisting of the school nurse, school medical advisor, student's physician, school principal and student's teacher (hereinafter "Team"). The Team shall consider the following when determining the educational setting:

1. Behavior of student;

2. Neurologic development;

3. Physical condition;

4. Existence of open sores that cannot be covered; and/or

5. Risk of transmission through normal school contacts.

C. A regular classroom setting will be provided unless, based on the considerations set forth in the preceding paragraph, it is determined that there is a risk of transmission through normal school contacts. If that risk exists, the student shall be removed from the classroom and placed in an appropriate alternate education program.

III. Removal from Classroom. A student temporarily removed from the classroom for severe or unusually aggressive behavior will be immediately referred to the aforesaid Team for assessment and the development of an appropriate program, if warranted.

A. A student temporarily removed from a classroom for weeping skin sores which cannot be covered may be provided homebound instruction, and will be re-admitted only when there is medical documentation that the risk no longer exists.

B. Removal from the classroom should not be the only response to reduce risk of transmission. The District will attempt to use the least restrictive means to accommodate the student’s needs.

C. The student may return to the classroom when the Team determines that the risk of transmission through the reasonably expected school contacts has abated.

D. The removal shall be reviewed by the Team once per month unless there is no reasonable medical need for medical review.

E. A student with HIV disease may be removed from the classroom for the student's protection when cases of life-threatening diseases (e.g., measles, chicken pox) arise in school.

1. The decision to remove the student will be made by the student's physician. The District may obtain a second opinion, at District expense, and the District will elect which opinion to follow if the District's second opinion conflicts with the student's physician's opinion.

2. In cases where the student is removed for the student's protection, the student may return to the classroom when the risk is abated.

F. The school nurse will act as a liaison between the Team members, assist the student in problem resolution and answer the student's questions, and act as the coordinator of services provided by other staff members.

IV. Privacy. The student's right to privacy shall be honored. Only those persons directly involved with a student with HIV disease or Hepatitis B will be advised of the student's condition. Such persons shall not divulge any of the information concerning the infected student to any other person unless authorized by law.

V. Handling Body Fluids. Routine procedures for handling blood, body fluids, vomitus and fecal or urinary incontinence should be followed regardless of whether there are any students with an infectious disease attending school.

VI. Definitions

A. HIV Disease. HIV disease is a severe, life threatening disease that progressively damages the immune system. The onset of clinical illness is usually insidious and characterized by nonspecific symptoms such as malaise, anorexia, fatigue, diarrhea, weight loss, lymphadenopathy, and fever. Eventually, the patient is afflicted with serious infections, frequently opportunistic. It is spread primarily by saliva, urine, blood, and semen.

B. Hepatitis B. Hepatitis B is a disease of the liver, usually has an insidious onset with anorexia, vague abdominal pain, nausea and vomiting, and occasionally joint pain and rash. Jaundice is often present, but fever may be absent or mild. It is spread primarily by saliva, urine, blood, and semen.

C. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulation and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

I. Introduction.

A. With no prior notice, life-threatening asthma attacks or systemic allergic reactions (anaphylaxis) that leave only minutes to save a life could necessitate an emergency response by school personnel. To maximize the chances that such an emergency response will result in full recovery, trained designated school personnel will administer epinephrine ("Epi-Pens") and nebulized albuterol treatments ("nebulizers") according to procedures that have been approved by the District’s Director of Student Services or designee.

B. Epi-Pens and nebulizers for emergency use will be distributed to every school within the District. Each District school will have Epi-Pens and nebulizers readily accessible in the health room or other designated area. These medications will be secured in a manner approved by the Director of Student Services to prevent unauthorized access.

C. Standing orders for District emergency supplies of Epi-Pens and albuterol will be signed by at least one (1) physician from the District’s Medical Advisory Committee.

D. Selected school personnel will be trained by qualified personnel to administer emergency nebulized albuterol and Epi-Pen injections under the supervision of the registered school nurse.

E. Parents, guardians, and emancipated students will be notified on the District's Emergency Health Form that Epi-Pens and nebulizers may be administered to students for life-saving purposes.

F. If parents, guardians, and emancipated students are aware of any medical condition that causes an Epi-Pen or nebulizer to be dangerous to a student, they should indicate on the Emergency Health Form the exact nature of the danger, and provide the District with the name and address of the medical provider who has made this determination.

G. Healthcare staff will follow protocols outlined in the State of Nebraska Attack on Asthma /Allergy Action Plan.

II. Availability, Storage, Use and Destruction. Each District school will have emergency supplies of Epi- Pens and nebulizers readily accessible. The following will govern the availability, storage, and use of the same:

A. All elementary schools will have both adult and pediatric emergency Epi-Pens available.

B. Emergency supplies of Epi-Pens and albuterol will be kept current, and will be disposed of on the reaching of the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control.

C. Unless the subject's medical condition and/or circumstances dictate otherwise, the following standing procedures for emergency response to life-threatening asthma attacks or anaphylaxis will be followed.

1. Call 911.

2. Summon the school nurse if available. If not, summon designated trained, non-medical staff to implement emergency protocol.

3. Check airway patency, breathing, respiratory rate, and pulse.

4. Administer medications (Epi-Pen and albuterol) per standing order.

a.  Administer an adult Epi-Pen IM for a child over fifty (50) pounds and Epi-Pen IM Junior for a child under fifty (50) pounds. The container for each dose and the container holding all dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.

b. Administer a nebulized albuterol, .05 percent, 0.5cc plus 2.5cc of saline administered by oral mask or mouthpiece. After the original administration, if not better, this dosage may be repeated two (2) more times. The container for individual dosages and containers holding non-individual dosages shall be marked "FOR EMERGENCY USE ONLY" in bold print.

5. Determine cause as quickly as possible.

6. Monitor vital signs (pulse, respiration, etc.).

7. Contact parents immediately and physician as soon as possible.

8. Any individual treated for symptoms with epinephrine at school will be transferred to a medical facility.

D. Emergency supplies of Epi-Pens, albuterol, and nebulizers will be under controlled access and maintained between fifty-nine (59) and eighty-five (85) degrees Fahrenheit as measured by a thermometer maintained in the same location in an air conditioned nurse's office or other air conditioned area designated by the school principal. Access will be limited to those individuals trained to administer these medications.

E. District emergency Epi-Pens and nebulizers will be administered to students or staff members for emergency use only. Students who need nebulized albuterol on a regular schedule must bring their own prescription and equipment for application in accordance with District Rule 5600.2. Emergency Epi-Pens and nebulizers may not be used under any circumstances other than emergency use.

F. District emergency Epi-Pens and nebulizers will not be used on field trips or other activities away from the school. District emergency medications are to be maintained at school during regular school hours so that the largest population of students may be served.

G. The school nurse will inspect the nebulizer monthly in their assigned area after each use to ensure that the equipment is in proper working order and is ready for the next usage. The school nurse will also periodically inspect the nebulizer to ensure that it is in working order and supplies of albuterol and Epi-Pens have not exceeded the recommended shelf life or when there is a color change in the epinephrine due to reaching or exceeding the expiration date or improper temperature control. The school nurse will provide an inventory which includes lot number of medications and the recommended shelf life.

H. All albuterol and Epi-Pens which have exceeded the recommended shelf life will be destroyed. The school nurse and principal shall keep a list which records when and how the albuterol and Epi- Pens were destroyed, and which district staff member oversaw the destruction.

III. Implementation and Training. Three (3) designated staff members from each school in addition to the school nurse will be trained in CPR, and in the administration of emergency Epi-Pens and nebulizers in life-threatening situations. Implementation and training shall include:

A. Designated staff members from each school will be appointed by a team consisting of the building principal or designee, the head nurse, the nurse serving the building, and approved by the Director of Student Services. No staff member other than District employed school nurses or health paraprofessionals shall be compelled through their employment status to serve as a designated staff member.

B. Training of the designated staff members will be conducted and completed prior to the distribution of Epi-Pens and nebulizers within the schools. Designated and trained staff members must complete annual training in order to continue serving as a designated staff member.

C. Training for the administration of Epi-Pens and nebulizers will be provided by a physician, a physician assistant, advanced practice registered nurse, or pharmacist trained in the use of Epi-Pens and nebulizers.

D. A certified CPR instructor will provide CPR training.

E. Designated staff members will successfully pass the competency assessment required by the Medication Aide Act no less than every three (3) years.


IV. In-Service Training. The procedure for the delegation of the administration of Epi-Pens and nebulizer treatments to trained special care providers should be followed in accordance with Health Services Guidelines. At a minimum, the training shall consist of the following:

A. A minimum of three (3) designated staff members in each school in addition to the school nurse trained in CPR should be in-serviced by the school nurse to:

1. Identify the signs and symptoms of a life-threatening asthma attack or systemic allergic reaction;

2. Follow District procedures for emergency treatment including required 911 calls and the administration of Epi-Pens and/or nebulizers;

3. Complete, as time permits, an Emergency Form for paramedics;

4. Review District procedures with the designated staff members a minimum of two (2) times during the school year;

5. At a minimum, training will be provided semi-annually for designated staff members who have already been trained and staff members who are newly appointed to the emergency team; and

6. Identify and record all students whose parents or guardian have indicated that use of Epi-Pens or nebulizers increases danger or is ineffective, and to provide follow-up investigation with medical providers to determine the exact nature of the danger.

B. At the conclusion of the in-service training, a Documentation of Competency form should be completed and filed in the Health Office.

C. The Director of Student Services will be responsible for overseeing what forms should be used to most effectively carry out the in-service training required under this Rule.


V. Baseline Training for Epi-Pens and Anaphylaxis. Orientation and instruction for the administration of Epi-Pens for life-threatening asthma or systemic allergic reactions should include:

A. Basic principles of the immune system and anaphylaxis;

B. Administration of Epi-Pens using an Epi-Pen Trainer;

C. Assessing vital signs;

D. Establishing and maintaining vital body functions and summoning emergency personnel; and

E. Proper documentation.

VI. Baseline Training for Nebulizers. Orientation and instruction for administering nebulizers should include:

A. Basic principles of the anatomy and physiology of the respiratory system;

B. Procedures for using nebulizers including set-up, administration, and storage;

C. Signs and symptoms of respiratory distress and reporting; and

D. Proper documentation.


VII. Post-Use Record. As soon as reasonably practicable following the emergency administration of an Epi- Pen or nebulizer, the designated staff members shall provide the Director of Student Services with a written report that should include, at a minimum, the following:

A. The circumstances giving rise to the administration of the Epi-Pen or nebulizer;

B. The results; and

C. The recommended changes in the procedures or forms used by the District in its administration of Epi-Pens and/or nebulizers, if any.


VIII. Annual Report. An annual report will be provided to the Nebraska Board of Pharmacy providing information on the number of incidents involving the administration of epinephrine and nebulized albuterol in the life-saving situations described in this Rule.


IX. Annual Review. On an annual basis, the Director of Student Services or designee will conduct a review of the effectiveness of this Rule, procedures utilized, forms adopted pursuant to this Rule, the post-use records of the District's designated staff members, and any other materials relevant to improving the District's use of Epi-Pens, nebulizers, and other emergency medications. The review will include, if practicable, the following:

A. A tabulation of the number of uses of Epi-Pens and nebulizers per school year;

B. The results of the use;

C. The recommendations from the District's Medical Advisory Committee or other qualified organization as it pertains to Epi-Pens and nebulizers; and

D. Upon the completion of the review, the Director of Student Services shall provide the Board with the Director's findings and recommendations.


X. Definitions.

A. CPR. CPR shall mean cardiopulmonary resuscitation.

B. Qualified Personnel. Qualified personnel shall mean individuals who have met an educational and/or legal requirement necessary to provide instruction on the use of the Epi-Pens and nebulizers.
 

I. Distribution and Placement of Automated External Defibrillators.

A. Introduction. Cardiac arrest is a threat for students, staff, or visitors to our schools and when it occurs, can leave only minutes to save a life. To maximize the chances that emergency response will result in full recovery, Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillators (AEDs) may be used. AEDs will be placed in each school, and trained designated school personnel will use AEDs according to procedures that have been approved by the Director of Student Services or designee.

B. AEDs will be distributed to every school within the District:

1. Each District high school will have, at minimum, three (3) AEDs readily accessible in designated area(s) where they are available for all students, staff and visitors.

2. Each District middle school will have, at minimum, two (2) AEDs readily accessible in designated area(s) where they are available for all students, staff and visitors.

3. Each District elementary school and the Keith Lutz Horizon High School will have, at minimum, one (1) AED readily accessible in designated area(s) where they are available for all students, staff and visitors.

4. The placement of AEDs will be determined by the principal. The principal will take into consideration that coverage must be provided for all activities and school functions that occur not only during the school day, but after school hours for school related activities.

a. AEDs will be placed in supervised areas where they can be observed by supervisory personnel or by surveillance cameras.

b. Each AED will be secured by an alarm device.

c. AEDs will not be placed in locked rooms or areas that limit availability after school hours.

d. Signs will be posted in each classroom, commons area, the office, and other areas of the building where students or staff congregate advising where the nearest AED is located.

5. AEDs will not be taken on field trips or other activities away from the school building unless an extra AED is solely dedicated for that purpose, the AEDs absence does not affect coverage at school, and the AED is under the constant direct supervision of a staff member trained in its use.

6. Groups, organizations, or individuals renting or using school facilities when school personnel are not present will be informed of the requirements for the use of AEDs.

C. Designated school personnel will be trained by qualified personnel to administer CPR and AEDs.

D. Parents, guardians, and emancipated students will be notified on the District's Emergency Health Form that in case of cardiac arrest, CPR and an AED may be administered to students for life- saving purposes.


II. AED Maintenance and Use. The following will govern the maintenance and use of AEDs:

A. AEDs will be maintained and tested in accordance with the operational guidelines of the manufacturer and monitored by personnel designated by the principal.

B. AEDs will be stored with the carrying case, one (1) extra set of pads, razor, latex or vinyl gloves, mouth barrier, and three (3) towelettes designed for use with the AED.

C. All AED pads that have exceeded the manufacturer’s recommended shelf life will be replaced.

D. Each AED will be inspected, at a minimum, monthly by the principal or designee to assure it is in proper working order and ready for immediate use. The AED will be inspected after each use to ensure that the equipment is in proper working order and is ready for the next usage.

E. Each AED will be marked with a District identification number.

F. The school nurse will maintain an inventory which includes the identification number of the AED, its location, and when it was last inspected.


III. Operating Procedures.

A. Unless the subject's medical conditions and/or circumstances dictate otherwise, the following standing procedures for emergency response cardiac arrest will be followed.

1. Call 911.

2. Administer the AED following the instructions on the AED.

3. Administer CPR as directed by the AED.

B. Notify the parents or guardians immediately at the first sign of a cardiac arrest. If trained designated staff members are involved in life-saving procedures, personnel not administering emergency treatment should provide the notice to the parents or guardians.

C. CPR and the AED will be administered by trained personnel to students, staff members, or visitors only when emergency life threatening events occur resulting from cardiac arrest.


IV. AED Training and Implementation.

A. The following designated staff members from each school will be trained on the use of CPR and AED(s):
 

1.    School nurses;
2.    Certified Nursing Assistants (CNA) and Certified Medical Assistants (CMA)
3.    Full-time health room paraprofessionals;
4.    One staff member from each Early Childhood classroom;
5.    Coaches and assistant coaches;
6.    Athletic trainers;
7.    Extracurricular supervisors who supervise physical activities; and
8.    A minimum of three (3) additional designated staff members from each school.

B. Designated staff members from each school will be appointed by the building principal or designee.

C. Training of the designated staff members will be conducted and completed prior to the distribution of AEDs within the schools.

D. Designated and trained staff members must maintain current CPR/AED certification in order to continue serving as a designated staff member.

E. Training for the administration of CPR and AEDs will be provided by a certified CPR instructor.


V. Purchase of AEDs.

A. All AEDs will be purchased through the District purchasing agent.

B. All AEDs will meet District specifications.

C. All AEDs will be of the same model and manufacturer.

D. Additional AEDs may be purchased and placed at any time by the individual school, if all of the requirements of this Rule are met.


VI. Post-Use Record. As soon as reasonably practical following the emergency administration of an AED, the designated staff members shall provide the Director of Student Services with a written report that should include, at a minimum, the following:

A. The circumstances giving rise to the administration of AED;

B. The results; and

C. The recommended changes in the procedures or forms used by the District in its administration of AEDs, if any.


VII. Annual Review. On an annual basis, the Director of Student Services or designee will conduct a review of the effectiveness of this Rule, procedures utilized, forms adopted pursuant to this Rule, the post-use records of the District's designated staff members, and any other materials relevant to improving the District's use of CPR and AEDs. The review will include, if practicable, the following:

A. The results of the use;

B. The recommendations from the District's Medical Advisory Committee or other qualified organization as it pertains to CPR and AEDs; and

C. Upon the completion of the review, the Director of Student Services shall provide the Board with the Director's findings and recommendations.


VIII. Definitions.

A. AED. AED shall mean Automated External Defibrillator.

B. CPR. CPR shall mean cardiopulmonary resuscitation.

C. Qualified Personnel. Qualified personnel shall mean individuals who have met an educational and/or legal requirement necessary to provide instruction on the use of CPR and AEDs.